Year 4 Passmedicine > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

features of acute asthma

A

worsening dyspnoea, wheeze and cough - not responding to SABA
history of resp tract infection

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2
Q

moderate acute asthma

A

PEFR 50-75%
speech normal
RR <25 and pulse <110

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3
Q

severe acute asthma

A

PEFR 33-50%
can’t complete sentences
EE >25
pulse >110

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4
Q

life-threatening acute asthma

A

PEFR <33%
O2 sats <92%
silent chest, cyanosis, bradycardia, hypotension
coma

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5
Q

what is a particularly worrying sign in acute asthma?

A

normal PCO2

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6
Q

near-fatal acute asthma

A

raised PCO2

mechanical ventilation

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7
Q

investigations acute asthma

A

abg sats <92%

CXR only if life-threatening or suspecting a penumothorax

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8
Q

who should be treated in hospital? acute asthma

A

all life-threatening
severe if fail to respond to initial treatment
previous near-fatal attack, pregnant, night presentation

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9
Q

acute asthma mnemonic

A 
Oxygen
saba
hydrocortisone (prednisolone)
ipratropium bromide
theophylline
magnesium sulphate
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10
Q

acute asthma - oxygen

A

if patients are hypoxaemic
15L NR mask
titrated to sats 94-98%

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11
Q

acute asthma - saba

A

high dose - salbutamol or terbutaline
pMDI (if not life-threatening)
nebulised

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12
Q

acute asthma - ccs

A

40-50mg oral prednisolone
continue for 5 days
continue inhaled ccs too

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13
Q

acute asthma - ipratropium

A

severe/life-threatening
SAMA
nebulised

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14
Q

acute asthma - MgSO4

A

severe/life-threatening

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15
Q

acute asthma - IV aminophylline

A

senior staff
fail to respond - ICU/HDU
intubate or ECMO

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16
Q

acute asthma - criteria for discharge

A

stable on discharge medication for 12-24 hours
inhaler technique
PEFR >75%

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17
Q

Acute bronchitis

A

chest infection of trachea and major bronchi
oedematous large airways and sputum
viral infection, winter

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18
Q

acute bronchitis symptoms and signs

A

cough
sore throat, rhinorrhoea
wheeze
low grade fever/wheeze

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19
Q

differentiate acute bronchitis and pneumonia

A

SOB in pneumonia

aswell as dullness to percussion, creps, bronchial breathing, myalgia

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20
Q

investigating acute bronchitis

A

clinical (CRP)

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21
Q

treating acute bronchitis

A

analgesia, fluids
abx if systemically unwell, co-morbid and high CRP
doxycycline
pregnant = amoxicillin

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22
Q

features of acute COPD

A

increase in SOB, cough, wheeze
increase in sputum
hypoxia, confusion

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23
Q

organisms - infective exacerbation of COPD

A

most common = H influenzae

S pneumoniae, Moraxella catarrhalis

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24
Q

acute COPD viral cause

A

Rhinovirus

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25
treating acute COPD
increase frequency of SABA (nebuliser) pred 30mg 5 days purulent sputum = amoxicillin or doxycycline or clarithromycin
26
what causes ARDS?
increased permeability of alveolar capillaries - fluid accumulation in alveoli mortality of 40%
27
causes of ARDS
``` infection - sepsis, pneumonia massive blood transfusion acute pancreatitis smoke inhalation cardio-pulmonary bypass ```
28
features of ARDS
acute and severe SOB, high RR, bilateral lung crackles | low O2 sats
29
ARDS key investigations
CXR and abg
30
ARDS criteria
American-European consensus conference 1. acute onset - within 1 wk 2. pulmonary oedema - bilateral infiltrates CXR 3. non-cardiogenic = pulmonary artery wedge P 4. PO2/FiO2 <40kPa
31
managing ARDS
ITU oxygen/ventilation vasopressors, abx, diuretics prone position, muscle relaxation
32
Allergic bronchopulmonary aspergillosis
allergy to aspergillus spores
33
Allergic bronchopulmonary aspergillosis history
bronchiectasis and eosinophilia
34
Allergic bronchopulmonary aspergillosis features
bronchoconstriction - wheeze, cough, SOB | proximal bronchiectasis
35
Allergic bronchopulmonary aspergillosis investigations
``` eosinophilia flitting CXR changes positive RAST positive IgG precipitins high IgE changes on CXR/CT ```
36
managing Allergic bronchopulmonary aspergillosis
oral CCS | itraconazole
37
Alpha-1 antitrypsin deficiency
lack of protease inhibitor produced by liver - protect cells from elastase autosomal recessive
38
Alpha-1 antitrypsin deficiency | features
emphysema in young, non-smokers (lower lobes) liver cirrhosis and HCC cholestasis
39
Alpha-1 antitrypsin deficiency | types
M = normal, S = slow, Z = v slow PiSS = 50% normal A1AT PiZZ (10% normal) - symptoms
40
Alpha-1 antitrypsin deficiency | investigations
A1AT concentrations | spirometry = obstructive
41
managing Alpha-1 antitrypsin deficiency
no smoking bronchodilators, physio Iv A1AT concentrate lung volume reduction surgery, transplant
42
3 main types of altitude related disorders
acute mountain sickness high altitude pulmonary oedema high altitude cerebral oedema
43
acute mountain sickness
self-limiting, 2500/3000m develops over 6-12 hours headache, nausea, fatigue
44
prevention and treating acute mountain sickness
no more than 500m a day acetazolamide descent
45
HAPE and HACE
HACE = headache, ataxia and papilloedema | above 4000m
46
managing HACE
descent | dexamethasone
47
treating HAPE
descent nifedipine, dexamethasone, acetazolamide phosphodiesterase type V inhibitors oxygen
48
5 steps to interpreting an abg
``` how is the patient? hypoxaemic? PaO2 acidaemic? pH <7.35 or alkalaemic? pH >7.45 PaCo2 bicarbonate ```
49
abg - paCo2
high - resp acidosis or compensating for metabolic alkalosis | low - resp alkalosis or compensating for metabolic acidosis
50
abg - bicarbonate
``` low = metabolic acidosis or renal compensation for resp alkalosis high = metabolic alkalosis or compensation for resp acidosis ```
51
abg - ROME mnemonic
Resp = opposite eg low ph and high pco2 = resp acidosis Metabolic = equal low ph and low bicarb = metabolic acidosis
52
what can asbestos do to the lung?
``` pleural plaques - benign pleural thickening asbestosis - lower lobe fibrosis mesothelioma lung cancer ```
53
mesothelioma
``` malignant disease of pleura crocidolite (blue) asbestos progressive SOB, chest pain, pleural effusion palliaitve chemo 8-14 months prognosis ```
54
aspiration pneumonia risk factors
``` poor dental hygiene swallow difficulties prolonged hospitalisation impaired consciousness impaired mucociliary clearance ```
55
aspiration pneumonia most common sites
right middle and lower lobe | vertical right main bronchus
56
bacteria in aspiration pneumonia
S pneumoniae staph aureus H influenzae Pseudomonas aeruginosa
57
asthma epidemiology
10% children, 5% adults | 1000 die a year
58
what is asthma?
chronic inflammatory disorder of airways type 1 hypersensitivity variable and reoccuring
59
asthma risk factors
``` personal/FH atopy antenatal: smoking, RSV low birth weight house dust mite, smoking, pollution hygiene hypothesis ```
60
atopy
atopic dermaitis allergic rhinitis asthma
61
what are patients with asthma sometimes sensitive to?
aspirin
62
occupational asthma
peak flows during week vs weekend | flour and isocyanates
63
asthma symptoms and signs
cough - night, SOB, wheeze expiratory wheeze reduced PEFR
64
asthma investigations
spirometry (variability saba) FeNO peak flow CXR
65
asthma - spirometry
volume and flow of air during exhalation and inhalation FEV1 reduced and FVC normal FEV1/FVC = reduced
66
asthma - FeNO
levels rise in eosinophils
67
asthma treatment
``` SABA - reliever, cause tremor ICS - taken everyday, oral candidiasis LABA LTRA - monteleukast under 5 = LTRA first (NICE) ```
68
asthma - MART
combined ICS and LABA | fast-acting LABA eg formoterol
69
asthma - steroids
start with low dose ICS = 400mg | stepping down = reduce by 25-50%
70
atelectasis
common post-op basal alveolar collapse SOB and hypoxaemia 72hrs position patient upright chest physio
71
causes of bilateral hilar LN
sarcoidosis TB lymphoma pneumocinosis/fungi
72
bronchiectasis
permanent dilatation of the airways secondary to chronic infection or inflammation
73
causes of bronchiectasis
``` post-infective eg TB, measles, pneumonia CF lung cancer/foreign body immune deficiency allergic bronchopulmonary aspergillosis ```
74
organisms bronchiectasis
H influenzae pseudomonas, klebsiella S penumoniae
75
managing bronchiectasis
``` physical training - inspiratory muscle training postural drainage abx bronchodilators immunisations surgery ```
76
chest drain
tube inserted into pleural cavity = one way valve to remove air or liquid
77
indications for chest drain
pleural effusion pneumothorax empyema haemotthorax
78
chest drain contraindications
INR >1.3 platelets <75 pulmonary bullae pleural adhesions
79
inserting a chest drain
``` assess images supine, 45 degrees forearm behind head 5th intercostal space midaxillary line - USS guided lidocaine seldinger technique secure with a stitch confirm position - swinging of tube ```
80
complications of chest drain
failure of insertion bleeding, infection penetration of lung re-expansion pulmonary oedema
81
re-expansion pulmonary oedema
clamp drain, urgent CXR | do not excees 1L in 6hrs
82
removing chest drain
no output >24hrs | resolution collection on imaging
83
chest drain - safe triangle borders
anterior border lat dorsi lateral border pec major superior horizontal nipple apex below the axilla
84
differentials for cavitating lung lesion on CXR
``` abscess - staph, klebsiella, pseudomonas SCC lung TB wegners PE RA aspergillosis ```
85
causes of lobar collapse
lung cancer asthma foreign body
86
signs of lobar collapse
tracheal deviation towards affected side mediastinal shift towards side elevation of hemidaphragm
87
lung mets
breast, colorectal, renal, bladder, prostate
88
lung mets CXR
multiple, well-defined | cannonball mets - Renal ca
89
CXR mediastinal widening
``` patient rotation thoracic artery aneurysm lymphoma teratoma thymus tumours do a lateral CXR or CT ```
90
correct Ng tube position
CXR - tip below diaphragm | checked by radiologist
91
CXR - pulmonary oedema
``` alveolar oedema - batwing kerley b lines - interstitial oedema cardiomegaly dilation of upper lobe vessels effusion ```
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white out of lung - trachea towards
pneumonectomy complete lung collapse pulmonary hypoplasia
93
white out of lung - central trachea
consolidation pulmonary oedema mesothelioma
94
white out of lung - trachea pushed away
pleural effusion | diaphragmatic hernia
95
causes of clubbing
``` cyanotic heart disease bacterial endocarditis lung cancer CF, bronchiectasis, TB crohns, cirrhosis, graves ```
96
coal workers pneumoconiosis
``` black lung - coal miners 15-20 years after exposure increase risk of COPD staging CXR 1,2,3 CXR - upper zones, spirometry compensation ```
97
causes of COPD
smoking A1At deficiency cadmium, coal, cotton, grain
98
COPD features
productive cough | SOB, wheeze, right-sided heart failure
99
COPD investigation
post bronchodilator spirometry CXR = hyperinflation, bullae, flat hemidiaphragm FBC - polycythaemia BMI
100
severity of COPD
``` post bronchodilator FEV1 >80% = mild FEV1 50-79% = mod FEV1 30-49% = severe FEV1 <30% = v severe ```
101
COPD - when to consider diagnosis
over 35, smoker, exertional SOB, chronic cough, regular sputum
102
COPD - long term oxygen
``` atleast 15 hours a day FEV1<30%, cyanosis, polycythaemia, peripheral oedema, raised JVP, O2 sats <92% abg - low PaO2 stopped smoking risk assessment ```
103
general advice COPD
stop smoking penumococcal and flu vaccine pulmonary rehab
104
treating COPD
SABA or SAMA asthmatic: ICS and LABA (with SABA only) non-asthmatic: LABA and LAMA SABA +LABA + LAMA + ICS
105
COPD asthmatic features
previous asthma/atopy higher eosinophil count substantial FEV1 variation over time diurnal peak flow variation
106
COPD - oral theophylline
trials of SABA and LABA | reduced dose if on macrolide/quinolone
107
COPD - prophylactic antibiotics
azithromycin | non-smokers, CT thorax, sputum culture, LFTs and ecg
108
COPD - mucolytics
considered
109
cor pulmonale
peripheral oedema, raised JVP, loud P2, systolic parasternal heave loop diuretic, long term O2
110
anion gap
(Na + K) - (Cl + HCO3)
111
normal anion gap metabolic acidosis
diarrhoea, renal tubular acidosis, acetazolamide, addisons
112
raised anion gap metabolic acidosis
DKA lactate -shock, hypoxia renal failure salicylates
113
lactic acidosis type A and B
``` A = shock, hypoxia B = metformin toxicity ```
114
causes of metabolic alkalosis
vomiting, diuretics, licquorice, hypokalaemia, cushings
115
causes of resp acidosis
COPD, life threatening asthma, BZD
116
causes of resp alkalosis
hyperventilation PE stroke, SAH pregnancy
117
granulomatosis with polyangiitis vs. eosinophilic granulomatosis with polyangiitis (wegners vs churg strauss)
``` wegners = renal failure, epistaxis, haemoptysis, cANCA churg-strauss = pANCA, asthma, eosinophilia both = vasculitis, sinusitis, SOB ```
118
Extrinsic allergic alveolitis
type 3 and 4 hypersensitivity | bird fanciers lung, farmers lung, mushroom worker
119
Extrinsic allergic alveolitis presentation
``` acute = SOB, dry cough, fever chronic = lethargy, SOB, productive cough, anorexia ```
120
Extrinsic allergic alveolitis investigation
imaging - upper/mid zone fibrosis BAL = lymphocytosis serology - IgG no eosinophilia on bloods
121
managing Extrinsic allergic alveolitis
avoid precipitant | oral glucocorticoids
122
managing wegners
steroids cyclophosphamide plasma exchange
123
wegners survival
8-9yrs
124
10 causes of haemoptysis
``` lung cancer TB PE pulmonary oedema LRTI bronchiectasis mitral stenosis goodpastures wegners aspergilloma ```
125
pulmonary oedema signs on examination
SOB, bibasal crackles, S3
126
mitral stenosis signs
SOB, AF, malar flush, mid-diastolic murmur
127
aspergilloma history
past TB, severe haemoptysis, CXR - round opacity
128
Idiopathic pulmonary fibrosis
50-70yrs, men progressive exertional SOB bibasal fine end inspiratory crackles dry cough and clubbing
129
Idiopathic pulmonary fibrosis investigations
``` spirometry - restrictive impaired gas exchange - reduced TLCO high res CT = ground glass and honeycombing CXR ANA +ve ```
130
managing Idiopathic pulmonary fibrosis
pulmonary rehab pirfenidone (antifibrotic) O2 and transplant
131
Idiopathic pulmonary fibrosis prognosis
3-4yrs
132
5 step inhaler technique
``` remove cap and shake breathe out gently put mouthpiece in mouth (air tight seal) and start to breate in slow and deep press canister down and inahle hold breath for 10s wait 30s for next dose ```
133
features of kartageners syndrome
dextrocardia bronchiectasis recurrent sinusitis subfertility
134
klebsiella
gram -ve rod - gut flora | aspiration pneumonia and UTI
135
features of klebsiella penumonia
alcoholics and DM aspiration redcurrant jelly sputum upper lobes
136
prognosis of klebsiella pneumonia
lung abscess and empyema | mortality 30-50%
137
features of lung cancer
``` persistent cough haemoptysis dyspnoea chest pain weight loss and anorexia hoarseness SVC syndrome ```
138
lung cancer hoarseness
pancoast tumour | recurrent laryngeal nerve palsy
139
lung cancer examination
fixed, monophonic wheeze supraclavicular LN persistent cervical LN clubbing
140
small cell lung cancer - paraneoplastic
ADH Lambert eaton syndrome ACTH - high bp, hyperglycaemia, muscle weakness
141
squamous cell lung cancer - paraneoplastic
PTH related protein hypercalcaemia hyperthyroidism hypertrophic pulmonary osteoarthropathy
142
lung cancer investigations
``` bloods - thrombocytosis CXR CT bronchoscopy - endobronchial USS guided PET scan ```
143
non-small cell lung cancer treatment
20% surgery - mediastinoscopy prior to assess mediastinal LN | curative or palliiatve radiotherapy
144
NSCLC surgery contraindications
``` stage 3b or 4 FEV1 <1.5L tumour near hilum vocal cord paralysis SVC obstruction malignant pleural effusion ```
145
lung cancer pathway
CXR - suggest lung cancer | over 40 unexplained haemoptysis
146
offer urgent CXR ?lung cancer
smoke + 1 symptom over 40 with 2 symptoms - cough, fatigue, SOB, chest pain, weight loss, appetite loss
147
consider urgent CXR ?lung cancer
persistent chest infections clubbing, LN thrombocytosis
148
SCLC
usually central ectopic ADH and ACT chemo and radiotherapy usually metastasised - worse prgnosis
149
NSCLC types
adenocarcinoma = non-smokers, peripheral squamous large cell
150
lung fibrosis - upper zones acronym
``` CHARTS coal workers pneumoconiosis histiocytosis/hypersensitivity ank spon radiation TB sarcoidosis ```
151
lung fibrosis - lower zones
idiopathic pulmonary fibrosis SLE asbestosis drug induced
152
superior mediastinum
``` SVC, aortic arch trachea thoracic duct vagus nerve phrenic nerve L recurrent laryngeal nerve oesophagus ```
153
anterior mediastinum
thymus, fat, LN
154
middle mediastinum
pericardium, heart, aortic root | main bronchi
155
posterior mediastinum
oesophagus, thoracic aorta azygos vein thoracic duct sympathetic nerve trunks
156
what lung affected in mesothelioma and spread
R lung | mets to contralateral lung and peritoneum
157
CXR - mesothelioma
pleural effusion or pleural thickening
158
investigations mesothelioma
CXR, pleural CT effusions - MC&S, biochem and cytology local anaesthetic thoracoscopy image guided pleural biopsy
159
Indications for NIV
COPD resp acidosis 7.25-7.35 type 2 resp failure - sleep apnoea, neuromuscular cardiogenic pulmonary oedema
160
Obstructive sleep apnoea risk factors
obesity macroglossia - hypothyroid large tonsils marfans
161
Obstructive sleep apnoea symptoms
daytime somnolence hypertension compensated resp acidosis
162
Obstructive sleep apnoea partner
excess snoring | periods of apnoea
163
assessing sleepiness Obstructive sleep apnoea
epworth sleepiness scale - patient and partner | multiple sleep latency test
164
diagnosing Obstructive sleep apnoea
polysomnography - pulse oximetry, eeg, snoring, resp airflow
165
managing Obstructive sleep apnoea
weight loss CPAP mandibular advancement excess daytime sleepiness - DVLA
166
oxygen dissociation curve shift to left
HbF carboxyhaemoglobin low PCO2, low temp
167
oxygen dissociation curve shift to right
acidic, high temp, raised PCO2
168
oxygen for critically ill patients
anaphylaxis, shock etc | 15L/min reservoir mask
169
oxygen sats
94-98% | hypercapnia: 88-92%
170
oxygen in COPD
before abg: 28% venturi 4L/min | PCO2 normal = aim 94-98
171
situations where oxygen not routinely used if no signs of hypoxia
MI and ACS (not if >94%) stroke anxiety hyperventilation obstetric emergencies
172
protein - transudate and exudate
transudate <30g/l protein | exudate >30g/l protein
173
common causes of transudate pleural effusion
heart failure hypoalbuminaemia - liver hypothyroidism meigs syndrome
174
common causes of exudate pleural effusion
``` infection - pneumonia (most), TB CTD - RA, SLE lung cancer, mesothelioma PE dresslers syndrome pancreatitis ```
175
features of pleural effusion
SOB, non-productive cough or chest pain | dullness to percussion, reduced air entry and reduced chest expansion
176
investigation of pleural effusion
PA CXR USS - pleural aspiration contrast CT
177
pleural effusion criteria
lights criteria - differentiate transudate and exudate - protein between 25-35g/l exudate likely if one of following: 1. pleural fluid protein/serum protein >0.5 2. pleural LDH/serum LDH >0.5 pleural fluid LDH >2/3 upper limit of normal serum LDH
178
pleural effusion - what is pleural aspirate sent for?
pH, protein, LDH, cytology and microbiology
179
characteristic pleural fluid findings and underlying cause
low glc = RA, TB raised amylase = pancreatitits, oesophageal perforation blood = mesothelioma, PE, TB
180
pleural effusion - managing pleural infection
purulent/cloudy - place chest tube | clear but pH <7.2 = chest tube
181
managing recurrent pleural effusions
recurrent aspiration pleurodesis indwelling pleural catheter opioids for SOB
182
causative organisms of pneumonia
S pneumoniae - 80% H influenzae moraxella catarrhalis
183
pneumonia in COPD
H influenzae
184
S pneumoniae
High fever, rapid onset and herpes labialis | penumococcal vaccine
185
S aureus pneumonia
after influenza
186
mycoplasma pneumoniae
atypical | dry cough, erythema multiforme, AIHA
187
legionella pneumohillia
atypical pneumonia hyponatraemia, lymphopenia air conditioning urinary antigen
188
PJP
HIV dry cough, exercise induced desaturations absence of chest signs
189
idiopathic intersititial pneumonia
non-infective eg COP - bronchiolitis after RA or amiodarone
190
symptoms and signs of pneumonia
cough, sputum, SOB, chest pain and fever fever, raised HR, low O2 sats reduced breath sounds, bronchial breathing
191
investigating pneumonia
``` CXR - consolidation bloods - neutrophilia, U+E, CRP blood and sputum cultures legionella urinary antigen abg ```
192
CURB 65
``` confusion urea >7 RR>30 Bp < 90 or 60 >65 ```
193
CURB65 scoring and where to manage them
0 = community 1 (sats >92%0 = CXR 2+ = hospital
194
pneumonia - point of care C|RP
``` <20 = no abx 20-100 = delayed prescription >100 = offer abx ```
195
managing low risk CAP
amoxicillin 5 days | doxycycline if allergic
196
managing mod-severe CAP
amoxicillin and macrolide 7-10 days | high risk = piperacillin with tazobactam and macrolide
197
discharge criteria for pneumonia
not discharged if any of these 2 in past 24 hours | - temp >37.5, RR>24, HR >100, bp <90, O2 <90% air, confusion, unable to eat
198
resolution of pneumonia
``` 1 week = fever 4 week = chest pain and sputum 6 weeks = cough and SOB 3 months = fatigue 6 months = normal ```
199
pneumothorax risk factors
COPD, asthma, CF, lung cancer marfans, rheumatoid NIV catamenial - endometriosis
200
symptoms of penumothorax
SOB, pleuritic chest pain | sweating, tachypnoea and tachycardia
201
managing primary Pneumothorax
<2cm and no symptoms = discharge aspiration >2cm and SOB = chest drain
202
managing secondary Pneumothorax
>2cm and SOB = chest drain 1-2cm = aspirate - chest drain <1cm = admit and give O2 avoid diving unless bilateral surgical pleurectomy
203
iatrogenic pneumothorax
majority resolve with observation aspiration COPD or ventilated - chest drain
204
psittacosis
``` chlamydia psittaci atypical pneumonia, parrot after cleaning bird cage flu-like and resp symptoms fail to respond to penicillin ```
205
psittacosis findings
unilateral creps and bronchial breathing rarely organomegaly CXR - consolidation serology
206
treating psittacosis
doxycycline | erythromycin
207
obstructive PFTs
FEV1 very reduced, FVC reduced or normal FEV1/FVC reduced COPD, asthma, bronchiectasis
208
restrictive PFTs
FEV1 reduced and FVC very reduced FEV1/FVC may be normal or increased pulmonary fibrosis, asbestosis, sarcoidosis, ARDs, neuromuscular
209
tidal volume
volume inspired and expired with each breath at rest | 500ml males, 350ml female
210
inspiratory and expiratory reserve volume
maximum volume inspired or expired at the end of a normal tidal inspiration or expiration
211
inspiratory capacity
TV + IRV
212
residual volume
volume of air remaining after maximal expiration | increases with age
213
functional residual capacity
volume in lungs at the end-expiratory position
214
vital capacity
max volume expired after maximal inspiration
215
no/delayed antibiotics for..
acute otitis media, acute pharyngitis, acute tonsillitis, common cold, acute bronchitis
216
centor criteria
absence of cough fever tonsillar exudate cervical LN
217
respiratory manifestations of RA
``` pulmonary fibrosis Pleural effusion pulmonary nodules infection side effects of methotrexate ```
218
sarcoidosis granulomas
non-caseating
219
sarcoidosis epidemiology
young, african
220
features of sarcoidosis
``` erythema nodosum bilateral hilar LN swinging fever SOB, malaise, cough lupus pernio hyperclacaemia ```
221
lofgrens syndrome
sarcoidosis with bilateral hilar LN, EN, fever, polyarthralgia
222
Mikulicz syndrome
sarcoidosis enlarged parotid and lacrimal glands (also with TB or lymphoma)
223
Heerfordts syndrome
parotid enlargement, fever and uveitis
224
sarcoidosis investigations
``` CXR - stage 0-4 hilar LN Serum ACE (monitoring) serum calcium, ESR spirometry - restrictive tissue biopsy ```
225
sarcoidosis treatment
steroids if | hypercalcaemia, eye/heart/neuro involvement, CXR stage 2/3
226
SOB heart failure
history of IHD or hypertension PND, orthopnoea bibasal crackles and S3 - left right = peripheral oedema, raised JVP
227
aortic stenosis SOB
angina, breathlessness, syncope | ejection systolic murmur
228
silicosis
fibrosing lung disease caused by inhaling fine silica risk factor for TB mining, potteries egg shell calcification of hilar LN
229
smoking cessation
offer bupropion or vareniciline- nicotine replacement
230
NRT side effects
N&V, headache | gum, nasal spray, patches
231
varenicline
``` nicotine receptor partial agonist start 1 week before intended stop date 12 week treatment nausea, suicidal behaviour not in pregnancy ```
232
bupropion
norepinephrine and dopamine reuptake inhibitor nicotinic antagonist small risk of seizures - ci in epilepsy and pregnancy
233
stopping smoking in pregnancy
CO detectors CBT, motivational interviewing NRT
234
tension penumothorax
lung parenchymal flap = one way valve trachea shifts and hyper resonance needle decompression and chest tube insertion
235
transfer factor
rate at which a gas will diffuse from alveoli into blood | CO used to test rate
236
cause of a raised TLCO
asthma, wegners, L to R cardiac shunt polycthaemia male, exercise
237
cause of low TLCO
pulmonary fibrosis, pneumonia, PE, pulmonary oedema, emphysema, anaemia
238
Increased KCO (corrected for lung volume) with low TCLO
pneumonectomy scoliosis neuromuscular weakness ankylosing spondylitis
Year 4 Passmedicine
flashcards
Decks in class (3)
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